Evidence-Based Medicine最新文献_第6页

Mental health literacy in primary care: Canadian Research and Education for the Advancement of Child Health (CanREACH). 初级保健中的心理健康素养:加拿大促进儿童健康的研究和教育(CanREACH)。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-22 DOI: 10.1136/ebmed-2017-110714

Eden S N McCaffrey, Samuel Chang, Geraldine Farrelly, Abdul Rahman, David Cawthorpe

{"title":"Mental health literacy in primary care: Canadian Research and Education for the Advancement of Child Health (CanREACH).","authors":"Eden S N McCaffrey, Samuel Chang, Geraldine Farrelly, Abdul Rahman, David Cawthorpe","doi":"10.1136/ebmed-2017-110714","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110714","url":null,"abstract":"The effectiveness of a continuing education programme in paediatric psychopharmacology designed for primary healthcare providers was objectively measured based on the assumption that training would lead to measurable changes in referral patterns and established clinical measures of referred patients. Using established, valid and reliable measures of clinical urgency embedded in to a regional healthcare system since 2002, the referrals to child and adolescent psychiatric services of physicians who participated in the training (n=99) were compared pretraining and post-training, and to non-participating/untrained referring physicians (n=7753) making referrals over the same time period. Referrals were analysed for evidence of change based on frequencies and measures of clinical urgency. Participants of the training programme also completed standardised baseline and outcome self-evaluations. Congruent with participants self-reported evaluative reports of improved knowledge and practice, analysis of referral frequency and the clinical urgency of referrals to paediatric psychiatric services over the study period indicated that trained physicians made more appropriate referrals (clinically more severe) and reduced referrals to emergency services. Quantitative clinical differences as completed by intake clinicians blind to referrals from the study group designations were observed within the trained physician group pretraining and post-training, and between the trained physician group and the unexposed physician group. The results illustrate a novel model for objectively measuring change among physicians based on training in paediatric mental health management.","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"123-131"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35190693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 18

Use of the M-CHAT follow-up interview (M-CHAT/F) by paediatricians during well-child care visits is feasible, valid and reliable. 儿科医生在儿童保健访问期间使用M-CHAT随访访谈(M-CHAT/F)是可行、有效和可靠的。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-06-29 DOI: 10.1136/ebmed-2016-110654

Thyde Dumont-Mathieu

引用次数: 1

Apixaban may have lower risk of GI bleeding compared with dabigatran and rivaroxaban in patients with atrial fibrillation. 与达比加群和利伐沙班相比，阿哌沙班在房颤患者中可能具有较低的胃肠道出血风险。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-13 DOI: 10.1136/ebmed-2017-110764

José Miguel Rivera-Caravaca, Gregory Y H Lip

引用次数: 2

The Cochrane Collaboration withdraws a review on methylphenidate for adults with attention deficit hyperactivity disorder. Cochrane协作撤回了一篇关于哌甲酯治疗成人注意缺陷多动障碍的综述。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-13 DOI: 10.1136/ebmed-2017-110716

Kim Boesen, Luis Carlos Saiz, Juan Erviti, Ole Jakob Storebø, Christian Gluud, Peter C Gøtzsche, Karsten Juhl Jørgensen

{"title":"The Cochrane Collaboration withdraws a review on methylphenidate for adults with attention deficit hyperactivity disorder.","authors":"Kim Boesen, Luis Carlos Saiz, Juan Erviti, Ole Jakob Storebø, Christian Gluud, Peter C Gøtzsche, Karsten Juhl Jørgensen","doi":"10.1136/ebmed-2017-110716","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110716","url":null,"abstract":"A Cochrane systematic review on immediate-release methylphenidate for adults with attention deficit hyperactivity disorder (ADHD) was withdrawn from the Cochrane Library on 26 May 2016 after substantial criticism of its methods and flawed conclusions. Retraction of scientific papers on this basis is unusual but can be necessary. We provide a summary of the criticism that led to the withdrawal. We detail the methodological flaws of the withdrawn Cochrane systematic review and general issues of bias and shortcomings of the included ADHD trials: cross-over designs compared with parallel-group designs, exclusion of participants with psychiatric comorbidity, absence of 'functional outcomes' and use of clinical outcomes with limited relevance, short trial duration and small trial populations, broken blinding caused by easily recognisable side effects, combining outcome assessments by trial investigators and participants, outcome reporting bias, poor evaluation of cardiovascular and psychiatric harms and conflicts of interest of trialists and systematic reviewers. The withdrawal of the Cochrane systematic review signals recognition of previous unreliable clinical ADHD research. We conclude that clinical trials of immediate-release methylphenidate in adults with ADHD are of very low quality. We urgently need well-conducted long-term trials free of bias to assess the benefits and harms of central stimulant treatment in adult ADHD.","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"143-147"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35166644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19

Percutaneous coronary intervention has similar 5-year survival rates to coronary artery bypass grafting surgery for patients with unprotected left main artery disease. 经皮冠状动脉介入治疗与无保护左主干疾病患者冠状动脉搭桥术的5年生存率相似。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-06 DOI: 10.1136/ebmed-2017-110682

Carlos Collet, Patrick W Serruys

{"title":"Percutaneous coronary intervention has similar 5-year survival rates to coronary artery bypass grafting surgery for patients with unprotected left main artery disease.","authors":"Carlos Collet, Patrick W Serruys","doi":"10.1136/ebmed-2017-110682","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110682","url":null,"abstract":"Commentary on: Makikallio T, Holm NR, Lindsay M, et al . Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016;388:2743–2752.\u0000\u0000An on-going debate is whether percutaneous coronary intervention (PCI) offers similar clinical results compared with coronary artery bypass grafting surgery (CABG) for patients with unprotected left main artery disease (ULMAD). Previously, the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) trial scrutinized the benefit of the first generation of drug-eluting stents in patients with multivessel disease and ULMAD. At 5 years, CABG was associated with improved clinical outcomes compared with PCI. Nonetheless, in patients with ULMAD and SYNTAX score <33, similar results were observed.1 The European and American guidelines agree upon the fact that in patients with ULMAD, CABG is the preferred treatment whereas PCI might be an alternative when the SYNTAX score …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"151-152"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35147545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Guidelines for reporting meta-epidemiological methodology research. 报告元流行病学方法学研究的指南。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-12 DOI: 10.1136/ebmed-2017-110713

Mohammad Hassan Murad, Zhen Wang

引用次数: 216

Determining clinical decision thresholds for HIV-positive patients suspected of having tuberculosis. 确定怀疑患有结核病的艾滋病毒阳性患者的临床决策阈值。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-17 DOI: 10.1136/ebmed-2017-110718

Tom Boyles, Isabella Locatelli, Nicolas Senn, Mark Ebell

{"title":"Determining clinical decision thresholds for HIV-positive patients suspected of having tuberculosis.","authors":"Tom Boyles, Isabella Locatelli, Nicolas Senn, Mark Ebell","doi":"10.1136/ebmed-2017-110718","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110718","url":null,"abstract":"Clinical decision thresholds may aid the evaluation of diagnostic tests but have rarely been determined for tuberculosis (TB). We presented clinicians with six web-based clinical scenarios, describing patients with HIV and possible TB at various sites and with a range of clinical stability. The probability of disease was varied randomly and clinicians asked to make treatment decisions; threshold curves and therapeutic thresholds were calculated. Test and treatment thresholds were calculated using Bayes theorem and the diagnostic accuracy of Xpert MTB/RIF. We received 165 replies to our survey. Therapeutic thresholds vary depending on the clinical stability and site of suspected disease. For inpatients, it ranges from 3.4% in unstable to 79.6% in stable patients. For TB meningitis, it ranges from 0% in unstable to 51.4% in stable patients and for pulmonary TB in outpatients it ranges from 29.1% in unstable to 74.5% in the stable patients. Test and treatment thresholds vary in a similar way with test thresholds ranging from 0 in unstable patients with suspected meningitis to 8.2% for stable inpatients. Treatment thresholds vary from 0 for unstable patients with suspected meningitis to 97% for stable inpatients. Therapeutic thresholds for TB can be determined by presenting clinicians with patient scenarios with random probabilities of disease and can be used to calculate test and treatment thresholds using Bayes theorem. Thresholds are lower when patients are more clinically unstable and when the implications of inappropriately withholding therapy are more serious. These results can be used to improve use and evaluation of diagnostic tests.","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"132-138"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35175577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Placebo might be superior to antipsychotics in management of delirium in the palliative care setting. 在姑息治疗中，安慰剂治疗谵妄可能优于抗精神病药物。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-06-21 DOI: 10.1136/ebmed-2017-110723

Soenke Boettger, Josef Jenewein

引用次数: 4

Clinicians should assess the benefits and risks of using bezlotoxumab for reducing the risk of recurrent Clostridium difficile infection. 临床医生应评估使用bezlotoxumab降低艰难梭菌感染复发风险的获益和风险。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-17 DOI: 10.1136/ebmed-2017-110722

Habiba Hassouna, Abhishek Deshpande

{"title":"Clinicians should assess the benefits and risks of using bezlotoxumab for reducing the risk of recurrent Clostridium difficile infection.","authors":"Habiba Hassouna, Abhishek Deshpande","doi":"10.1136/ebmed-2017-110722","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110722","url":null,"abstract":"Commentry on: Wilcox MH, Gerding DN, Poxton IR, et al . Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med 2017;376:305–317.\u0000\u0000Clostridium difficile is an anaerobic gram-positive spore-forming bacillus that plays a major role in healthcare antibiotic-associated diarrhoea. A continued rise in antibiotic use, specifically, cephalosporins and fluoroquinolones, has been linked to the development of more resistant strains of this toxin-forming pathogen, triggering more recurrences and severe manifestations of the disease across USA and Europe.1 The high burden of recurrence and increased healthcare costs associated with C. difficile infection (CDI) have encouraged the development of new treatments to prevent recurrence including the use of pulsed/tapered oral vancomycin, fidaxomicin and faecal microbiota transplantation (FMT).2 \u0000\u0000Monoclonal antibodies for C. difficile therapy (MODIFY) trials I and II are two global phase 3 trials aimed at examining the efficacy and safety of a single dose (10 mg/kg) of human monoclonal antibodies actoxumab and bezlotoxumab against C. …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"150-151"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35176157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Induction of labour at 37 weeks for suspected fetal macrosomia may reduce birth trauma. 怀疑胎儿巨大儿的37周引产可减少分娩创伤。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-06-23 DOI: 10.1136/ebmed-2017-110693

Kate Walker, Jim Thornton

引用次数: 2